The Taming Sneaky Fears Program:
Development and Refinement
5.1 Creation of the Taming Sneaky Fears Program
children and help them master abstract concepts. Monga wrote stories specifically for young children with the goal of teaching them complex concepts, like the CBT strategies that older children were learning to utilize in their group CBT sessions.
Monga’s early stories included engaging characters that brought to life, concretized, and simplified abstract and complex CBT concepts such as how to recognize, identify, and label anxiety and other feelings, how to use relaxation strategies to manage anxiety symptoms, how to understand and discuss cognitive distortions, and how to use cognitive coping strategies.
Monga incorporated large animal puppets, some of which personified the main story characters, as a means to further concretize complex and abstract concepts and actively engage five- to seven-year-old children during the group CBT sessions.
Throughout the evolution of the Taming Sneaky Fears program, the large animal puppets have served three additional purposes as they have: (1) provided a form of exciting distraction to counteract the distress that some children might experience as their parents depart during the first child group session; (2) promoted active engage- ment by the children, as children are encouraged to choose a puppet at the start of each group and hold on to it when the story is read; and (3) allowed for children to possibly feel more comfortable speaking about anxiety symptoms their puppet experiences rather than talking about their own anxiety.
Monga also recognized the need for structure in each session, not only because CBT sessions are typically structured and manualized, but also because many preschool and kindergarten programs use predictable and consistent structure and routines to support children in their learning, and young children typically enjoy structure and predictability as this gives them a sense of control and mastery. To mirror what is done in many preschool and kindergarten programs, Monga divided the group sessions with the children into a Circle Time (when children sit in a circle, share activities that have taken place or are planned in between sessions, and review the concepts learned during the previous group CBT session), a Story Time (when children listen to a new story each week that engages children and illustrates a cen- tral CBT concept), a Craft Time (when children complete drawings to help process, reinforce, and complement the key concept taught during Story Time), and a Snack Time (when children share a snack to promote socialization among the children and between children and child group therapists). The structure for each group CBT ses- sion has remained consistent through the several refinements brought to the Taming Sneaky Fears program over time.
Another aspect of the program that has remained consistent over the years is the use of puppets to portray Sneaky Fears. In the Taming Sneaky Fears program, the child’s anxiety, fears, or worries are externalized and given the name, ‘Sneaky Fears.’
A lot of thought was put into the portrayal of the Sneaky Fears’ story character, the puppets used during group sessions to represent Sneaky Fears, and the timing of Sneaky Fears’ first appearance in the group sessions. Monga viewed the puppets portraying Sneaky Fears popping out unexpectedly in the middle of the story as a necessary vehicle to allow children to externalize their anxiety symptoms and make
anxiety concrete. Here were two sneaky, somewhat intimidating looking puppets2 that made scary, untrue, and exaggerated statements and prevented the story’s central character from doing things he wanted or needed to do, just like the anxiety, fears, and worries that prevent the children attending the group from doing things they want or need to do. The squeals of excitement from the children when Sneaky Fears make their first appearance, the continued enjoyment and excitement whenever the Sneaky Fears puppets appear in the group sessions, and the children’s ability to verbalize that Sneaky Fears use Tricks to make children feel shy, nervous, and scared, suggested to Monga and her colleagues that young children enjoy and understand the concept that Sneaky Fears portrays. The name Sneaky Fears was created to both externalize anxiety and portray the unexpected way in which anxiety ‘sneaks up,’ interferes with what children want or need to do, and makes children feel shy, nervous, and scared.
5.1.2 Development of the Parent Component
The parent component of the Taming Sneaky Fears program began as a stand-alone program for parents of children with anxiety disorders under the age of eight years, created in the early 2000s by Mary Owens, a psychiatrist and colleague of Monga’s.
As noted in Chap. 4, like other centers around that time, our anxiety clinic used a parent-focused intervention to teach parents strategies to use with their anxious children rather than having young children participate directly in treatment. As such, Owens developed a 12-week, parent-only group program that included weekly 60 minute sessions that focused on providing parents with psychoeducation about anxiety, temperament, and how to manage their children’s anxiety and behavioral concerns. The original, manualized parent program provided parents with guidance and training by a therapist, as well as a forum for parents of anxious children to support each other.
5.1.3 Combining Child and Parent Components
In 2002, Monga’s newly created Taming Sneaky Fears child component for five- to seven-year-old children (Sect.5.1.1) was combined with Owen’s parent component (Sect.5.1.2) to become the first 12-session, manualized Taming Sneaky Fears group CBT program. No modifications were made to Owen’s 12-session parent group program and the new eight-session child group program was simply incorporated into the parent treatment protocol. Therefore, the first Taming Sneaky Fears group program consisted of four weekly, 60 minute parent-only sessions, followed by eight
2The puppets portraying Sneaky Fears have changed over time, going from a single dragon puppet in the early stages of development to two separate, annoying and rather unpleasant jackal-like puppets in the current program, to accommodate the changes brought to the story over time.
weekly, 60 minute parent group and child group sessions that ran separately but concurrently. One parent group therapist led the parent group sessions, while two child group therapists led the child group sessions. The first child group session began with parents and children participating in a ten- to 15-minute warm-up or ice- breaker activity in the child group room, followed by a separation upon completion of the ice-breaker activity. For all subsequent sessions, parent and child groups ran concurrently but separately in adjacent rooms.